The Annals of thoracic surgery
-
The management of bronchial fistula associated with acute lung injury raises two major concerns: (1) high ventilation pressures are necessary for lung recruitment but detrimental for fistula healing, and (2) adequate lung recruitment is prevented by large air leak. Primary surgical closure of bronchial fistula should be attempted but is rarely successful during mechanical ventilation. We sought to evaluate the efficacy of extracorporeal membrane oxygenation associated with lung-protective ventilation in case of failure of conventional management. ⋯ If correctly timed, extracorporeal membrane oxygenation can provide a therapeutic bridge to lung-protective ventilation and allow bronchial fistula healing in case of refractory respiratory failure.
-
Comparative Study
The right internal thoracic artery: the forgotten conduit--5,766 patients and 991 angiograms.
The right internal thoracic artery (RITA) is biologically identical to the left ITA, yet is rarely used in coronary artery bypass graft surgery (CABG). We examined the results and long-term patency of RITA grafts. ⋯ Late patencies of RITA are excellent, equivalent to the LITA for identical territories, always better than radial arteries and saphenous vein grafts, and remain free of atheroma. Use of RITA in addition to LITA is associated with excellent survival in triple-vessel coronary disease. More extensive use of the RITA in CABG is recommended.
-
This study evaluated the role of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in the assessment of newly developed mediastinal/hilar abnormalities in patients with previously treated lung cancer. ⋯ EBUS-TBNA can differentiate a new primary lung cancer from recurrence of previously treated lung cancer, which will facilitate treatment strategy.
-
In contrast to mitral valve repair, residual and recurrent regurgitation after tricuspid valve (TV) repair for functional tricuspid regurgitation (TR) is common. We have systematically used undersized, rigid 3-dimensional annuloplasty rings to treat functional TR. ⋯ Tricuspid valve repair with an undersized (size 26 or 28) rigid 3-dimensional annuloplasty ring is the method of choice for reliable and durable treatment of functional TR.